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Implementation best practices

Teeing up telemedicine

Published Thursday, October 10, 2019 11:50 am

Telemedicine has been gaining a lot of steam in recent years. And it has become an increasingly important component of healthcare delivery.

As a result, provider organization CIOs and other health IT leaders have had their hands full finding and implementing new telemedicine technologies to help their organizations best reach as many patients as possible in the most efficient manner as possible.

Here, five telemedicine technology experts offer best practices for implementing the technology. They share their hard-fought wisdom from years of experience working with this unique health IT. And they offer advice on a comprehensive array of topics health IT workers face when working in the field of telehealth.

Rally support from the top down

As with any technology implementation, it is true that the trickle-down effect is real: When there is buy-in, support and strategy from the top, that shared vision and overall feeling will easily transfer throughout the rest of the organization, said Dr. Roy Schoenberg, CEO and co-founder of American Well, a telemedicine technology vendor.

“So, the first critical best practice when implementing telemedicine technology is to have a clinical leader with long-term vision, one who can rally true support from the broader team,” he advised. “These leaders must be willing to reimagine – and communicate – what care delivery looks like with telehealth incorporated into an evolved strategy, as opposed to duplicating real-world experience in a virtual environment.”

Leadership also should work to harness existing relationships and build consensus around telehealth technology strategy to inform why stakeholders should participate in a telehealth program, which will ultimately increase buy-in, he added.

“CIOs will need to rally peer ‘sponsors’ at the executive, operational and clinical levels, collaborating to create an integrative performance plan that includes defined objectives, short- and long-term goals, as well as puts forward rewards/consequences tied to success,” Schoenberg said. “Once a more structured vision and plan is in place, it’s critical to also have a team that fulfills specific roles – from onboarding to implementation to ongoing training.”

Dedicated telehealth resources from operations and IT form the program team and can work with clinicians and vendors to develop, implement and train other providers, he continued. Once in place, organizations should establish a governance structure to help inform the teams working to deliver this technology and how it expands across the enterprise, he said.

End user adoption and engagement

Wendy Deibert, RN, vice president of clinical solutions at Caregility, a telemedicine technology vendor, said her first best practice is to realize that a telemedicine implementation is not about the equipment or installing the equipment in a location.

“The bigger challenge is getting end user adoption and engagement to employ the technology for its intended purpose,” she explained. “For every piece of technology there needs to be clinical workflow design that embeds the use of the equipment into the clinician’s current daily or frequent workflow.”

Anyone can install equipment or technology and train clinicians on how to technically use it: However, the information will be lost very quickly if it is not used routinely or becomes a time hindrance to their current workflow, she added.

“This workflow must be designed with the end user who will use this technology, not an IT or management group,” Deibert cautioned. “They know best what will work and what will fail. They need to build a flowchart of what their current practice is and then figure out how the technology will be added into their current workflow.”

Once that is completed, they need to run mock simulations to validate the workflow is working as designed or reiterate until it works, she advised. If one does not listen, design, document and re-iterate these workflows, over time the chances the telemedicine technology will be used or successful is very slim, she said.

Engage key stakeholders early on

Like Schoenberg and Deibert, Eric Rock, CEO of Vivify Health, a telemedicine technology vendor, advised that healthcare provider organizations implementing telehealth technology should identify and engage key stakeholders early on.

“Obtaining buy-in, commitment, excitement and engagement from your executive and clinical teams, or at least one committed sponsor from each group, from the onset of your program, is key to ensuring program success,” said Rock.

“Once approval to proceed has been obtained, you must identify who your clinical resources are, gain an understanding of their workflows and ascertain their goals, as these folks are the ones ultimately responsible for keeping your patient population out of the hospital.”

All stakeholders must be on board – from those who are selecting patients to apply for the program to the clinical resources monitoring the patients themselves, he added. The entire team must be motivated toward a common goal and committed to working together on a clearly defined, common mission, he advised.

Another implementation best practice that Rock offered is for CIOs and clinical leaders to understand their target population.

“Before implementing a telehealth or remote patient monitoring program, it is critical to truly understand the population you’re targeting,” he cautioned. “Start by drilling down into their capabilities – for example, are they limited in an emotional or physical capacity that would require additional levels of service? Or, perhaps, is their condition so degraded that they should only receive the minimal amount of technology?”

Additionally, what financial and clinical outcomes is the organization targeting? What are the limiting factors of the target population (such as comfort level with technology) and how much technology is simply too much? All of these factors must be considered and weighed appropriately when creating the supported workflows and implementing the chosen technology, Rock said.

Align the approach with organizational strategy

When implementing telehealth technology, healthcare provider organizations must align the telemedicine approach with organizational strategy, said Zachary Tisch, senior director, strategic implementation, at Pivot Point Consulting and a consultant who specializes in telemedicine.

“In our engagements with clients that have truly transformed their delivery model through the use of a variety of telemedicine solutions, the common thread has been having laser focus and tight alignment between the overall organizational goals and how telemedicine technologies or services can help support those goals,” Tisch recalled.

“Too often organizations focus on the technology, but at the end of the day to drive utilization it is important to understand the use-cases and patient flow patterns in your marketplace,” he said.

For example, organizations with a large rural patient catchment area have benefitted from using telemedicine to provide services typically not available in rural settings such as sub-specialist outpatient care (for instance, electrophysiology services to evaluate pacemaker or implanted defibrillator patients via telemedicine) or acute care (for instance, tele-stroke program to evaluate emergency department patients for stroke).

“Performing an initial market analysis, both in the community and directly with patients, is critical to determining when and where to roll out telemedicine or virtual visit programs,” said Tisch.

“Simply launching the technology will not drive the benefits most organizations are looking for. It is critical to focus on particular use-cases and service lines with a direct marketing focus around those use-cases, such as a virtual video visit to be evaluated for the flu, decongesting the emergency room and urgent cares.”

Align service line leaders with telemedicine programs

Another best practice is to align service line leaders, such as clinical directors, with the telemedicine programs, and have the utilization be driven by operations, not IT, he said.

“IT should stand up and support the technology, but it is important that, as an example, the cardiology practice director takes ownership and accountability for cardiology telemedicine services,” he said. “This allows you to leverage your existing leaders and chain of command for advocates to identify new use-cases and also ensure that the use of these technologies fit into the overall growth model for the service line in question.”

Telemedicine should no longer be seen as a technology, but instead as a clinical solution that is supported by technology, he added.

On another front, buy-in from the clinical community, and in particular the physicians, also is critical for success and adoption of telemedicine as a true clinical service offering, Tisch advised.

“This is particularly important when working with community partners for programs to expand specialty services,” he said. “Your providers can become advocates for these services and help drive growth without additional marketing cost/investment.”

Carefully define telehealth challenges

Gigi Sorenson, RN, chief clinical officer at GlobalMed, a vendor of telemedicine and virtual health technologies, said that a telemedicine technology implementation best practice is to define challenges carefully.

“Before starting any telehealth implementation, be sure to map out the clinical needs to address any infrastructure challenges,” she said. “In terms of healthcare access, do you want to bring care to patients in remote areas or monitor elderly or disabled patients at home? Are you solving a shortage of medical specialists and services?”

Also, identify cost saving priorities, such as reducing high hospital readmission rates and no-show appointments, she added.

“Finally, think through your system workflows,” she advised. “How will telemedicine encounters be captured and stored? How will they interface with EHR and PAC systems? What communication networks will be involved – and how will any network gaps be addressed?”

How different disciplines use telemedicine

American Well’s Schoenberg added another best practice, saying that healthcare organizations need to understand that telehealth may be used differently across disciplines.

“A hospital leader should understand that different clinical teams across disciplines may use telehealth technology differently for their patient demographics,” he said. “For example, surgical departments may want to use it to follow patients to prevent readmissions after discharge. Oncology, on the other hand, may want to use telemedicine to minimize necessary travel and avoid hospital trips for chemotherapy patients.”

Pediatrics may want to use it to prevent hospital anxiety for kids who need to be followed frequently, he added. Each has its own subtlety, but the likelihood of success is much higher when each group “invents” how it wants to use telehealth and emotionally subscribes to its success, he offered.

“No matter how it’s used, however, remember to prioritize change management and clinical transformation – and understand that new technology implementation is not always an overnight success,” Schoenberg said. “Leaders must be the first to acknowledge how much time and purpose must be addressed to make telehealth implementation a bigger part of digital transformation across the continuum of care.”

Simplify the technology footprint

Smart healthcare organizations implementing telehealth programs will simplify the technology footprint and proactively manage the process, said Tisch of Pivot Point Consulting.

“While the technology platform itself will not single-handedly make or break the success of your telemedicine program, the more successful offerings on the market have taken a methodical approach to simplify the hardware platform, implementation process and support/monitoring model,” he said.

“This extends to both the hardware itself, which should be a streamlined form factor that should be easy to use and attractive to the patient, as well as the software, which needs to offer a simple connection on the other end – whether patient or provider partner – without troubleshooting or having to reference documentation.”

Elsewhere, Tisch cautioned that higher-cost solutions are not always best – organizations have had great success using generic tools for video conferencing and off-the-shelf webcam products and microphones rather than expensive, dedicated telemedicine hardware platforms that age quickly and often require additional maintenance or support.

Another best practice from Tisch: Proactively support the utilization of a telemedicine platform by providing routine end user and patient surveys, reviewing system metrics, and monitoring a dashboard on a weekly basis showing utilization, with emphasis on new patients, repeat patients and percent of telemedicine encounters that were completed successfully.

“Embed these metrics into your organizational goals at the department or service line levels and report on them in a broad and transparent manner,” he advised. “Encourage the sharing of best practices through a dedicated telemedicine program coordinator who can optimize the program and ensure your organization receives the most value it can for the technology investment made.”

The easier one makes it for patients and caregivers to engage with an organization via telemedicine, the more likely they are to try it, he added.

“Reduce the number of clicks, provide completed marketing, and simplify the end user experience as much as possible, even if it may cause more work for your clinicians,” he said. “One method to do this is via an initial triage process through questionnaires at the time of scheduling, allowing the patient – within no more than a small handful of questions – to self-select the appropriate telemedicine service and provider for their needs. Software algorithms can be leveraged to drive this process, as well.”

Planning to go beyond traditional uses

Video technology can be used in healthcare to connect two or more people together for many purposes beyond traditional telemedicine, including patient assessment, check-ins, observation, support and more, said Deibert of Caregility.

“It is also a great way to build life-long relationships with patients and families, just like being face to face,” she said. “We see provider organizations expanding the use of 2-way audio/video technology to build stronger relationships between clinicians, staff, patients and families. While the best way to communicate with patients is face to face – with full facial expressions, seeing the person’s eyes, and hearing the tone and clarity of their voice – technology can fill gaps.”

How a clinician presents himself across the camera will determine how the clinician/patient/family relationship evolves, she added. If faces are dark and not well lit on the video, there is no way to see facial expressions, or expressions in the eyes. If the audio is choppy or degraded in any way, the message will not be understood.

“Video conferencing is much like TV broadcasting and every consideration should be taken for putting a clinician on video,” said Deibert. “Training and education must be provided to show clinicians how to position oneself on video, show your health system brand, troubleshoot quickly, communicate empathy and compassion, and assess the conversation.”